Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019)

Table 1 Prevalence of non-alcoholic fatty liver disease based on gender and race from the national inpatient sample analysis (2019)

Prevalence of NAFLD	Count	%	Total hospitalizations
Sex	NAFLD diagnoses
Male	195475	1.5%	12978685
Female	213655	1.2%	17236228
Race	NAFLD-related diagnoses
White	264475	1.3%	19851043
Black	43875	1.0%	4519150
Hispanic	66265	2.0%	3262700
Asian-Pacific Islander	9995	1.2%	826270
Native American	3745	1.9%	201155
Others	13250	1.5%	858436

NAFLD: Non-alcoholic fatty liver disease.

Table 2 Baseline characteristics, comorbidities and outcomes in non-alcoholic fatty liver disease hospitalizations by sex, 2019, n (%)

		Male	Female	P value
Age (yr) at admission, median [IQR]		55 [43-65]	55 [42-67]
Race	White	67.0	64.8	< 0.001
	Black	10.1	11.7	< 0.001
	Hispanic	15.9	17.0	< 0.001
	Asian-Pacific Islander	2.7	2.3	< 0.001
	Native American	0.9	1.0	< 0.001
	Others	3.4	3.2	< 0.001
Median household income national quartile for patient ZIP code	0-25	28.3	30.3	< 0.001
	25-50	25.4	26.1	< 0.001
	50-75	25.6	24.8	< 0.001
	75-100	20.7	18.7	< 0.001
Primary expected payer	Medicare	32.6	36.2	< 0.001
	Medicaid	20.2	22.2	< 0.001
	Private including HMO	34.0	33.0	< 0.001
	Self-pay	8.6	5.9	< 0.001
	No charges	0.9	0.5	< 0.001
	Others	3.8	2.2	< 0.001
Elective versus non-elective admission	Non-elective	88.2	80.4	< 0.001
	Elective	11.8	19.6	< 0.001
Region of hospital	Northeast	17.3	16.5	< 0.001
	Midwest	21.4	20.6	< 0.001
	South	38.1	39.3	< 0.001
	West	23.2	23.6	< 0.001
Location/teaching status of hospital	Rural	6.0	6.2	< 0.001
	Urban non-teaching	18.0	18.9	< 0.001
	Urban teaching	76.0	74.8	< 0.001
Comorbidities
Hypertension, complicated		18.5	16.3	< 0.001
Hypertension, uncomplicated		45.1	42.5	< 0.001
Diabetes with chronic complications		21.7	21.0	< 0.001
Diabetes without chronic complications		13.5	15.8	< 0.001
Hyperlipidaemia		41.5	38.6	< 0.001
Obesity		32.3	43.6	< 0.001
Peripheral vascular disease		6.8	4.9	< 0.001
Prior MI		5.8	3.4	< 0.001
Drug abuse		6.5	4.4	< 0.001
Tobacco use disorder		25.3	17.5	< 0.001
Chronic pulmonary disease		18.7	25.0	< 0.001
Prior TIA/stroke without neurologic deficit		4.2	4.6	< 0.001
Prior VTE		4.7	5.2	< 0.001
In-hospital outcomes
MACCE (ACM/AMI/CA/stroke)		6.2	4.6	< 0.001
All-cause mortality		1.4	1.3	0.001
AMI - all diagnoses T1/T2MI combined		3.4	2.2	< 0.001
Acute VTE		2.8	2.2	< 0.001
Dysrhythmia		15.1	10.7	< 0.001
Cardiac arrest		0.7	0.5	< 0.001
Stroke		1.5	1.3	< 0.001
Disposition of patient	Routine discharge	73.3	73.2	< 0.001
	Transfers to short term facilities	2.4	1.8	< 0.001
	Other: Includes SNF, ICF, another type of facility	9.4	10.1	< 0.001
	HHC	10.7	12.0	< 0.001
	AMA	2.8	1.5	< 0.001
Length of stay (d), median [IQR]		3 [2-6]	3 [2-5]	< 0.001
Total charges (USD), median [IQR]		40952 [23123-75209]	41695 [24443-72705]	< 0.001

P < 0.05 indicates statistical significance. NAFLD: Non-alcoholic fatty liver disease; HMO: Health Maintenance Organization; MACCE: Major adverse cardiovascular and cerebrovascular events; ACM: All-cause mortality; MI: Myocardial infarction; AMI: Acute myocardial infarction; CA: Cardiac arrest; T2MI: Type 2 myocardial infarction; TIA: Transient ischemic attack; VTE: Venous thromboembolism; SNF: Skilled Nursing Facility; ICF: Intermediate Care Facility; HHC: Home Health Care; AMA: Against medical advice.

Table 3 Baseline characteristics, comorbidities and outcomes in non-alcoholic fatty liver disease hospitalizations by race, 2019

Variables		White	Black	Hispanic	Pacific Islander	Native American	Others	Total	P value
Age at admission		57	53	48	56	48	52	55
Sex	Male	48.6	44.2	46	51	44.3	49.8	47.8	< 0.001
	Female	51.4	55.8	54	49	55.7	50.2	52.2	< 0.001
Median household income national quartile for patient ZIP code	0-25	24.6	48.7	37.3	12.6	47.4	29.1	29.4	< 0.001
	25-50	26.6	22.5	25.5	16.9	26.6	23.6	25.7	< 0.001
	50-75	26.8	17.8	23.6	28.1	19.2	24.5	25.2	< 0.001
	75-100	21.9	11.1	13.6	42.4	6.7	22.8	19.8	< 0.001
Primary expected payer	Medicare	38.8	32.1	21.8	31	23.8	25	34.5	< 0.001
	Medicaid	16.4	28.5	33.5	19.3	45.8	26.8	21.2	< 0.001
	Private including HMO	35.4	27.8	28.7	41.5	18.8	33.4	33.4	< 0.001
	Self-pay	5.9	8	11.9	5	5.4	10.6	7.2	< 0.001
	No charges	0.5	0.7	1.5	0.6	0.1	0.7	0.7	< 0.001
	Others	3	2.8	2.6	2.6	6	3.5	2.9	< 0.001
Elective versus non-elective admission	Non-elective	83.4	86	85.7	86.5	88	83.7	84.2	< 0.001
	Elective	16.6	14	14.3	13.5	12	16.3	15.8	< 0.001
Region of hospital	Northeast	17.6	16.1	13.9	15.8	2.9	28.9	17	< 0.001
	Midwest	24.8	21	7.2	9.6	17.9	10.3	20.6	< 0.001
	South	39.1	51.2	35.1	17.6	19	36.7	39	< 0.001
	West	18.5	11.7	43.7	57.1	60.2	24.2	23.4	< 0.001
Location/teaching status of hospital	Rural	7.8	3.5	1.7	1	15.2	2.5	6.1	< 0.001
	Urban non-teaching	19.1	14.4	19.4	18.2	16.3	16.9	18.5	< 0.001
	Urban teaching	73.1	82.1	78.9	80.8	68.5	80.6	75.5	< 0.001
Comorbidities
Hypertension, complicated		17.9	23.5	12	18.6	15.5	12.6	17.4	< 0.001
Hypertension, uncomplicated		45.3	45.7	37.6	40.9	36	40.8	43.7	< 0.001
Diabetes with chronic complications		20.6	24.3	22.2	26	22.2	18.5	21.4	< 0.001
Diabetes without chronic complications		14	14.3	16.7	18.4	16.3	15.9	14.6	< 0.001
Hyperlipidaemia		42.3	35	34.4	49.9	25	36.4	40	< 0.001
Obesity		38	39.7	40.5	23.1	35.4	36.2	38.2	< 0.001
Peripheral vascular disease		6.6	4.9	3.8	8.4	2.1	3.9	5.8	< 0.001
Prior MI		5.2	4.3	2.6	3.9	3.7	2.8	4.6	< 0.001
Drug abuse		5.4	7.3	4.3	3	9.3	4.3	5.4	< 0.001
Tobacco use disorder		22.9	26	13.1	12.2	25.9	16.7	21.2	< 0.001
Chronic pulmonary disease		24.3	23.7	14.4	14.2	20.7	16.7	22.1	< 0.001
Prior TIA/stroke		4.6	5.7	3.3	4	2.9	3.1	4.4	< 0.001
Prior VTE		5.5	6.3	2.8	2	1.7	3.5	5	< 0.001
In-hospital outcomes
MACCE (ACM/AMI/CA/stroke)		5.6	5.5	4.2	6.6	4.9	5.3	5.3	< 0.001
All-cause mortality		1.4	1.4	0.9	1.7	2.1	1.2	1.3	< 0.001
AMI		2.9	2.6	2.2	3.4	1.9	3.1	2.7	< 0.001
Acute VTE		2.6	2.8	1.9	1.8	0.9	2	2.5	< 0.001
Dysrhythmia		15	10.7	6.6	11.5	6.9	9.3	12.8	< 0.001
Cardiac arrest		0.6	0.7	0.4	0.5	0.4	0.6	0.6	< 0.001
Stroke		1.3	1.7	1.3	1.8	0.9	1.2	1.4	< 0.001
Disposition of patient	Routine discharge	70.9	73.1	81.2	74.6	78.1	78	73.2	< 0.001
	Transfers to short term facilities	2.2	1.7	1.7	2.2	2.8	2.1	2.1	< 0.001
	Other1	11.2	9.8	5.2	8.5	7.2	6.3	9.8	< 0.001
	HHC	12.3	11	9.1	11.7	5.9	9.7	11.4	< 0.001
	AMA	2	3	1.9	1.3	3.9	2.7	2.1	< 0.001
Length of stay (d), median		3	4	3	3	3	3	3	< 0.001
Total charges (USD), median		39745	39028	48351	51003	35127	45309	41448	< 0.001

¹Includes Skilled Nursing Facility, Intermediate Care Facility, Another Type of Facility.

P < 0.05 indicates statistical significance. NAFLD: Non-alcoholic fatty liver disease; HMO: Health Maintenance Organization; MACCE: Major adverse cardiovascular and cerebrovascular events; ACM: All-cause mortality; MI: Myocardial infarction; AMI: Acute myocardial infarction; CA: Cardiac arrest; TIA: Transient ischemic attack; VTE: Venous thromboembolism; AMA: Against medical advice.

Table 4 Adjusted odds of major cardiovascular and cerebrovascular events, all-cause mortality, acute myocardial infarction, cardiac arrest, stroke by age, gender and race

Groups	MACCE		All-cause mortality		AMI		Cardiac arrest		Stroke
	aOR (95%CI)	P value	aOR (95%CI)	P value	aOR (95%CI)	P value	aOR (95%CI)	P value	aOR (95%CI)	P value
18-44	Reference	< 0.001	Reference	< 0.001	Reference	< 0.001	Reference	< 0.001	Reference	< 0.001
45-64	2.31 (2.06-2.59)		3.00 (2.42-3.72)		2.23 (1.87-2.66)		2.08 (1.55-2.80)		1.90 (1.52-2.38)
≥ 65	3.01 (2.61-3.47)		4.13 (3.11-5.48)		2.81 (2.29-3.45)		2.24 (1.52-3.31)		2.58 (1.96-3.39)
Male vs female	1.22 (1.14-1.30)		1.04 (0.92-1.18)	0.539	1.35 (1.24-1.48)	< 0.001	1.54 (1.26-1.88)	< 0.001	1.04 (0.01-1.19)	0.579
White	Reference	0.125	Reference	0.001	Reference	0.121	Reference	0.272	Reference	0.377
Black	1.00 (0.90-1.11)		0.89 (0.72-1.10)		0.95 (0.81-1.11)		1.16 (0.86-1.57)		1.25 (1.03-1.53)
Hispanic	0.88 (0.79-0.98)		0.69 (0.56-0.85)		0.93 (0.81-1.08)		0.75 (0.55-1.02)		1.07 (0.87-1.31)
Asian/Pacific Islander	1.06 (0.86-1.30)		1.18 (0.82-1.69)		1.06 (0.81-1.38)		0.77 (0.42-1.43)		0.99 (0.69-1.42)
NA	1.14 (0.81-1.61)		1.64 (1.04-2.60)		0.91 (0.53-1.56)		0.74 (0.25-2.15)		0.86 (0.41-1.81)
Others	1.11 (0.92-1.34)		0.91 (0.62-1.33)		1.33 (1.06-1.67)		1.05 (0.62-1.78)		0.99 (0.68-1.45)

Multivariable logistic regression was adjusted for baseline patient and hospital level characteristics, and relevant pre-existing cardiovascular and extra-cardiac comorbidities. AMI: Acute myocardial infarction; aOR: Adjusted odds ratio; MACCE: Major adverse cardiac and cerebrovascular events.